FORM 144

OMB APPROVAL

OMB Number:   3235-0101
Expires:   June 30, 2017
Estimated average burden
hours per response   1.00

 

 

UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

 

FORM 144

 

NOTICE OF PROPOSED SALE OF SECURITIES

PURSUANT TO RULE 144 UNDER THE SECURITIES ACT OF 1933

 

   SEC USE ONLY
  

DOCUMENT SEQUENCE NO.

 

  

CUSIP NUMBER

 

   WORK LOCATION
    
ATTENTION:

Transmit for filing 3 copies of this form concurrently with either placing an order with a broker to execute sale or executing a sale directly with a market maker.

 

1 (a) NAME OF ISSUER (Please type or print)

        Farmers & Merchants Bancorp, Inc.

 

(b) IRS IDENT. NO.

        34-1469491

 

(c) S.E.C. FILE NO.

        001-38084

1 (d) ADDRESS OF ISSUER    STREET    CITY                   STATE              ZIP CODE       (e) TELEPHONE NO.
                 AREA CODE     NUMBER
        307 N Defiance St.       Archbold   OH      43502           419            446-2501

2 (a) NAME OF PERSON FOR WHOSE ACCOUNT
        THE SECURITIES ARE TO BE SOLD

        Paul S. Siebenmorgen

        

(b) RELATIONSHIP TO         ISSUER

    Executive Officer

 

(c) ADDRESS STREET

 

        405 Quail Run

      

CITY

 

Archbold

    

STATE

 

OH

    

ZIP CODE

 

43502

INSTRUCTION: The person filing this notice should contact the issuer to obtain the I.R.S. Identification Number and the S.E.C. File Number.

 

3 (a)                   (b)       SEC USE ONLY   (c)   (d)   (e)   (f)   (g)

Title of the

Class of

Securities

To Be Sold

 

Name and Address of Each Broker Through Whom

the Securities are to be Offered or Each Market

Maker who is Acquiring the Securities

 

 

Broker-Dealer 

File Number

 

Number of Shares 

or Other Units

To Be Sold

(See instr. 3(c))

 

Aggregate

Market Value

 

(See instr. 3(d))

 

Number of Shares 

or Other Units

Outstanding

(See instr. 3(e))

 

Approximate

Date of Sale

(See instr. 3(f))

(MO. DAY YR.) 

 

Name of Each

Securities

Exchange

(See instr. 3(g))

               
COMMON  

Investment Planners, Inc

PO Box 170

Decatur, IL 62525

      15,000   $654,000 (3)   9,284,061   9/17/2018   NASDAQ
               
                             
               
                             

 

INSTRUCTIONS:

1.

  (a)   Name of issuer
  (b)   Issuer’s I.R.S. Identification Number
  (c)   Issuer’s S.E.C. file number, if any
 

(d)

(e)

 

Issuer’s address, including zip code

Issuer’s telephone number, including area code

2.

  (a)   Name of person for whose account the securities are to be sold
  (b)   Such person’s relationship to the issuer (e.g., officer, director, 10% stockholder, or member of immediate family of any of the foregoing)
  (c)   Such person’s address, including zip code
3.   (a)   Title of the class of securities to be sold
  (b)   Name and address of each broker through whom the securities are intended to be sold
  (c)   Number of shares or other units to be sold (if debt securities, give the aggregate face amount)
  (d)   Aggregate market value of the securities to be sold as of a specified date within 10 days prior to the filing of this notice
  (e)  

Number of shares or other units of the class outstanding, or if debt securities the face amount thereof outstanding, as shown by the most recent report or statement published by the issuer

Approximate date on which the securities are to be sold

  (f)
  (g)   Name of each securities exchange, if any, on which the securities are intended to be sold
 

 

Potential persons who are to respond to the collection of information contained in this form are not

required to respond unless the form displays a currently valid OMB control number.

  

SEC 1147 (08-07)


TABLE I — SECURITIES TO BE SOLD

Furnish the following information with respect to the acquisition of the securities to be sold

and with respect to the payment of all or any part of the purchase price or other consideration therefor:

 

Title of

the Class

  

Date you  

Acquired  

   Nature of Acquisition Transaction   

Name of Person from Whom Acquired

(If gift, also give date donor acquired)

   Amount of
Securities Acquired    
  

Date of  

Payment  

   Nature of
Payment
COMMON        

10/7/2004

10/7/2004

9/6/2005

    

11/22/2005

3/13/2006

9/7/2006

    

12/8/2006

  

Purchased by Individual IRA

Purchased by Joint

Stock Award

    

Purchased by Individual IRA

Purchased by Individual IRA

Stock Award

    

Purchased by Individual IRA

       

Open Market

Open Market

Acquired through Company’s Long Term Incentive Plan

Open Market

Open Market

Acquired through Company’s Long Term Incentive Plan

Open Market

       

2,832 (1) (2)

2,400 (1) (2)

800 (1) (2)

    

2,000 (1) (2)

3,168 (1) (2)

1,200 (2)

    

4,000 (2)

       

10/7/2004

10/7/2004

N/A

    

11/22/2005

3/13/2006

N/A

    

12/8/2006

  

Cash

Cash

N/A

    

Cash

Cash

N/A

    

Cash

INSTRUCTIONS:    If the securities were purchased and full payment therefor was not made in cash at the time of purchase, explain in the table or in a note thereto the nature of the consideration given. If the consideration consisted of any note or other obligation, or if payment was made in installments describe the arrangement and state when the note or other obligation was discharged in full or the last installment paid.

 

 

TABLE II — SECURITIES SOLD DURING THE PAST 3 MONTHS

 

Furnish the following information as to all securities of the issuer sold during the past 3 months by the person for whose account the securities are to be sold.

 

Name and Address of Seller   Title of Securities Sold   Date of Sale       Amount of    
Securities Sold    
  Gross Proceeds    
         
                 

 

REMARKS:   Footnote (1) - All shares indicated reflect a 4-for-1 split of the Issuer’s Common Stock which became effective 5/12/2006.
  Footnote (2) - All shares indicated reflect a 2-for 1 split of the Issuer’s Common Stock which became effective 9/20/2017.
  Footnote (3) - Based on the closing price of the Issuer’s Common Stock on the NASDAQ stock market on September 13, 2018

 

INSTRUCTIONS:

See the definition of “person” in paragraph (a) of Rule 144. Information is to be given not only as to the person for whose account the securities are to be sold but also as to all other persons included in that definition. In addition, information shall be given as to sales by all persons whose sales are required by paragraph (e) of Rule 144 to be aggregated with sales for the account of the person filing this notice.

    

ATTENTION:

The person for whose account the securities to which this notice relates are to be sold hereby represents by signing this notice that he does not know any material adverse information in regard to the current and prospective operations of the Issuer of the securities to be sold which has not been publicly disclosed. If such person has adopted a written trading plan or given trading instructions to satisfy Rule 10b5-1 under the Exchange Act, by signing the form and indicating the date that the plan was adopted or the instruction given, that person makes such representation as of the plan adoption or instruction date.

 

9/14/2018

DATE OF NOTICE

    

 

/s/ Paul S. Siebenmorgen

(SIGNATURE)

 

DATE OF PLAN ADOPTION OR GIVING OF INSTRUCTION,

IF RELYING ON RULE 10B5-1

     The notice shall be signed by the person for whose account the securities are to be sold. At least one copy of the notice shall be manually signed. Any copies not manually signed shall bear typed or printed signatures.

 

ATTENTION: Intentional misstatements or omission of facts constitute Federal Criminal Violations (See 18 U.S.C. 1001)

SEC 1147 (02-08)